Foot and Ankle Arthritis

What is foot and ankle arthritis?

Arthritis is a disease that involves gradual loss of cartilage inside a joint. Cartilage is the smooth layer that covers the ends of bones and helps them move easily and without pain. When cartilage breaks down, the bones underneath can rub against each other, leading to joint pain, swelling, and inflammation. In foot and ankle arthritis, symptoms affect one or more of the 30 joints in your ankles and feet.

While getting arthritis from everyday wear and tear is common in the knees and hips as we age, arthritis in the feet and ankles is often linked to past injuries, such as fractures near these joints. If you’re experiencing persistent foot and ankle pain, se it’s important to talk to a healthcare provider.

Most people start with nonsurgical treatments, such as wearing braces, taking medications, or doing physical therapy. These approaches often help relieve symptoms. Surgery is only considered if these treatments don’t provide enough relief.

At Mass General Brigham Orthopedics, you have a trusted partner in your orthopedic care. We’re experts in identifying, diagnosing, and treating foot and ankle arthritis.

Call 857-282-3300 to schedule a consultation or find a foot and ankle specialist.

Types of foot and ankle arthritis

Many types of arthritis can affect your feet and ankles, including:

• Osteoarthritis: Osteoarthritis is the most common kind of arthritis found in the hip and knee. It can also affect the ankle, but this happens less often. It develops when the protective cushioning at the ends of bones (cartilage) deteriorates. This deterioration is common as people age.
• Post-traumatic arthritis: This type of arthritis develops after a major joint injury, such as a dislocation or fracture, and is the most common form of arthritis in the ankle. The injury damages cartilage, which can lead to breakdown and inflammation over time.
• Gout: Gout develops because the body has too much uric acid, a waste product. Uric acid crystals build up in joints, causing painful attacks of swelling and inflammation. Gout arthritis often affects the big toe.
• Rheumatoid arthritis: Rheumatoid arthritis is an autoimmune condition, which means it develops because the immune system mistakenly attacks healthy tissues and joints. Rheumatoid arthritis causes inflammation and swelling in the lining of joints.

Location of foot and ankle arthritis

Foot and ankle arthritis can affect your:

• Ankle joint: Where your lower legs join your feet
• Hindfoot: Back of the foot at the heel
• Midfoot: Middle section of your foot, including your arch and the top of your foot
• Forefoot: Ball of the foot and toes

Foot and ankle arthritis symptoms

Foot and ankle arthritis often develops slowly, so it’s common not to realize you have it right away. In the beginning, symptoms are often worst first thing in the morning and go away when you start moving. This is called “start-up pain and stiffness” and is a common sign of early arthritis.

Some types of arthritis cause symptoms to come and go, while others cause constant symptoms. You may experience:

• Discolored skin around the joint
• Joint pain
• Reduced mobility in your ankle, foot, or toes
• Swelling
• Tenderness or warmth around the joint

What causes foot and ankle arthritis?

The specific cause of foot and ankle arthritis depends on the type you have. Some factors can increase your risk of arthritis, including:

• Age: Osteoarthritis usually develops after age 50, while rheumatoid arthritis is most common between ages 35 and 50.
• Sex: Most types of arthritis are more common in women, while gout tends to affect men more often. Post-traumatic arthritis tends to affect men more often, while rheumatoid arthritis is more commonly seen in women.
• Family history: You’re more likely to get arthritis if you have an immediate family member with the condition.
• Health conditions: Some health conditions, such as the autoimmune disease lupus, make you more likely to develop some types of arthritis. You’re also more likely to develop osteoarthritis if you have obesity.
• Health habits: Smoking or using tobacco products increases your risk of arthritis.
• History of injuries: Foot and ankle injuries increase your risk of post-traumatic arthritis, especially if you’ve injured the same joint repeatedly.

Diagnosing foot and ankle arthritis

Diagnosing foot and ankle arthritis starts with discussing your symptoms and examining the joint. Your provider may ask:

• Do symptoms affect one or both feet?
• What activities worsen or relieve symptoms?
• What symptoms bother you most?
• When did symptoms start?

Your provider may watch you walk or test your foot and ankle’s range of motion. They may also order tests such as:

• Blood tests to look for markers of rheumatoid arthritis or check uric acid levels
• Imaging tests, such as an X-ray, to look for cartilage wear and tear

Foot and ankle arthritis treatment

Your treatment plan depends on the type of arthritis you have and how severe it is. The goal of treatment is to reduce your symptoms and improve your quality of life.

Orthotics/Braces

Orthotics are shoe inserts that support and align your foot and ankle. Braces provide ankle and foot support to further correct ankle and hindfoot alignment that might not be sufficiently corrected by orthotics. Your provider may recommend that you purchase a certain type of over-the-counter orthotic or brace, or they might prescribe a custom-made one just for you. Custom orthotics or braces are made by a specialist called an orthotist and usually take about four to six weeks to be ready.

There are many places where you can get orthotics, and your provider may have a list of recommended options if you ask for suggestions.

Medications

Over-the-counter medicines such as nonsteroidal anti-inflammatory drugs (NSAIDs) often reduce pain and inflammation. Your provider may also prescribe medications such as:

• Stronger anti-inflammatory drugs that require a prescription
• Oral or injectable corticosteroids to decrease inflammation—these are rarely prescribed by orthopedic surgeons because they can cause side effects throughout your body
• Medications that help slow the progression of rheumatoid arthritis, called disease-modifying antirheumatic drugs (DMARDs) and immunosuppressive drugs—these are usually prescribed by a rheumatologist after your orthopedic surgeon makes a referral

Steroid injections

Your provider can give you a steroid injection directly into the joint that hurts. This method is usually safer than taking steroids by mouth or by muscle injection because it results in fewer side effects throughout your body.

Steroid injections help reduce pain and swelling in the joint. Your provider may use imaging tools like X-rays or ultrasound to guide the injection, but sometimes these aren’t needed. While these injections can bring relief, they may cause side effects such as infection, skin lightening at the injection site, temporary increases in blood pressure or blood sugar, and thinning of the fat under your skin. To help avoid problems, these injections are generally only given every three to four months.

Physical therapy

A physical therapist may teach you exercises to increase strength and range of motion. You practice these exercises between sessions to improve your foot and ankle mobility.

Surgery

If nonsurgical treatments don’t bring relief, your provider may recommend surgery. Your options may include:

• Arthroscopy: This procedure is minimally invasive, meaning it uses small incisions and a tiny camera to help the surgeon remove bone spurs and inflamed tissue from the joint. It works best for early-stage arthritis and is usually not recommended if the arthritis is more advanced or moderate.
• Joint fusion: During this procedure, your surgeon permanently joins (fuses) the affected bones in your foot or ankle to help stabilize the joint and ease your pain. After the fusion, the joint will be stiff, but it should no longer hurt. Most people can walk comfortably and close to normally. Other nearby joints in your foot and ankle will still move and help support your walking, so you likely won’t notice any major change in how you walk.
• Joint replacement: Your surgeon removes the damaged ankle joint and replaces it with artificial parts made of metal and plastic, similar to how hips and knees are replaced. It's important to know that this option is available only for the ankle joint—there are currently no replacement surgeries for the smaller joints in the foot below the ankle.

How to prevent foot and ankle arthritis

You can’t always prevent foot and ankle arthritis. However, some lifestyle changes can lower your risk, including:

• Avoiding tobacco products and quitting smoking if you’ve already started
• Eating a healthy, nutrient-dense diet and maintaining an optimal weight
• Exercising regularly
• Wearing protective equipment and proper footwear during sports and other physical activities

Frequently asked questions